Provider Demographics
NPI:1639781123
Name:MONTALBO, BRYCE (APRN)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:MONTALBO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 750033
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-7833
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:
Practice Address - Street 1:500 ALA MOANA BLVD STE 6230
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4929
Practice Address - Country:US
Practice Address - Phone:808-524-6115
Practice Address - Fax:808-528-1711
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3005363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty